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Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features

Michael Absoud1, Ming J Lim, Wui K Chong

  • 1School of Health and Population Sciences, University of Birmingham, Birmingham, UK. michaelabsoud@childdemyelination.org.uk

Multiple Sclerosis (Houndmills, Basingstoke, England)
|April 21, 2012
PubMed

Insights

This study found the highest incidence rates of childhood acquired demyelinating syndromes (ADSs) in the British Isles. Early diagnosis of pediatric multiple sclerosis (MS) at first ADS presentation is crucial for treatment and research.

Area of Science:

  • Pediatric Neurology
  • Epidemiology
  • Neuroimmunology

Background:

  • Epidemiological trends in multiple sclerosis (MS) may first emerge in pediatric populations presenting with acquired demyelinating syndromes (ADSs).
  • Understanding the incidence and characteristics of childhood ADSs is vital for early detection and management of potential MS.
  • Previous studies have not comprehensively assessed childhood ADS in the British Isles.

Purpose of the Study:

  • To determine the incidence of childhood central nervous system ADSs in the British Isles.
  • To investigate the clinical, investigative, and magnetic resonance imaging (MRI) features of these childhood ADSs.
  • To establish baseline data for future epidemiological studies and clinical trial designs in pediatric MS.

Main Methods:

  • A population-based active surveillance study was conducted from September 2009 to September 2010.
  • Paediatricians and ophthalmologists reported suspected cases of ADEM, CIS, and NMO using standardized definitions and criteria.
  • MRI scans were reviewed, and data were collected via questionnaires to confirm diagnoses and gather clinical information.

Main Results:

  • The incidence of first-onset ADS in children aged 1-15 years was 9.83 per million child-years.
  • Clinically isolated syndrome (CIS) accounted for 66.4% of cases, acute disseminated encephalomyelitis (ADEM) for 32.0%, and neuromyelitis optica (NMO) for 1.6%.
  • A female predominance was observed in children over 10 years, and a trend towards higher incidence in South Asian and Black children compared to White children was noted. MRI characteristics differentiated ADEM from CIS.

Conclusions:

  • This study reports the highest surveillance incidence rates of childhood ADS to date.
  • Diagnosing pediatric MS at the initial ADS presentation has significant implications for clinical practice and the design of pediatric clinical trials.
  • Further research is needed to understand the long-term outcomes and specific risk factors for childhood ADSs.
Abstract

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